A prospective study of the relationship between body mass index and cataract extraction among US women and men

Abstract

BACKGROUND: Obesity may influence several physiologic processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress. OBJECTIVE: To examine the association between increased body mass index (BMI) and the incidence of cataract extraction. DESIGN AND SETTING: The Nurses' Health Study and the Health Professionals Follow-up Study, both prospective cohort studies of US women and men. SUBJECTS: A total of 87 682 women and 45 549 men aged 45 y and older who did not have diagnosed cataract or cancer at baseline (1980 for women, 1986 for men). MEASUREMENTS: Cataract extractions occurring between baseline and 1996, confirmed by medical records. RESULTS: During 16 y of follow-up in the women, and 10 y in the men, (1 097 997 person-y), 4430 incident cases were documented. Compared to participants with BMI less than 23 kg=m 2 , those with BMI greater than or equal to 30 kg=m 2 had 36% higher risk of any type of cataract (pooled multivariate relative risk (RR), 1.36; 95% CI, 1.23 -1.49) after adjusting for smoking, age and lutein=zeaxanthin intake. The association was strongest for posterior subcapsular (PSC) cataract (pooled multivariate RR, 1.99; 95% CI, 1.55 -2.55). With adjustment for diabetes, the RR of obesity associated with posterior subcapsular cataract was 1.68 (95% CI, 1.30 -2.17). Obesity was not significantly associated with nuclear cataract. CONCLUSION: Obesity increases the risk of developing cataract overall, and of PSC cataract in particular; the etiology of PSC cataract may be mediated at least in part by glucose intolerance and insulin resistance, even in the absence of clinical diabetes.

Obesity and Eye Diseases

“…The relationship between obesity and cataract has been investigated in many epidemiological studies, 10,21,22,53,63,74,86,94,107,108,121,126,129,144,168,197,211,222 but the findings are not universally consistent ( Table 1). The strongest evidence are based on prospective data from several large population-based studies demonstrating positive association between obesity and cataract.…”

“…65, 169 Furthermore, obesity has also been linked to cataract by its associated complications such as diabetes, 1, 52, 115, 127, 130, 183 glucose intolerance, insulin resistance, 69 hyperlipidemia and hypertension. They are all known risk factors for cataract, 74,96,101,129,197,211,222 but the primary role of these factors in catarctogenesis is less clear.…”

“…The strongest evidence are based on prospective data from several large population-based studies demonstrating positive association between obesity and cataract. 63,73,86,107,168,211 In 1995 63 and 2000, 168 the Physicians' Health Study, a randomized trial of 22071 healthy male American physicians aged 40-84 years, reported both overall obesity, measured as BMI, and abdominal adiposity, measured as waist-to-hip ratio (WHR), as independent risk factors for cataract. It was found that at any given level of BMI, a 2-unit higher level predicted a 12% increase risk of cataract.…”

“…Obesity has recently been reported to be negatively associated with visual acuity, 10 but the ocular conditions underlying this association and the potential implications are unclear. Amongst different eye diseases, obesity has been associated with cataract, 1,21,53,63,86,94,107,108,121,129,168,211,222 age-related maculopathy, 2, 28, 167, 173 diabetic retinopathy, 8, 24, 83, 114, 171, 207 and glaucoma. 60, 127, 225 However, these associations have not been consistently documented.…”

Increased risk of cataract development in WNIN‐obese rats due to accumulation of intralenticular sorbitol

“…Among these disorders, cataract is the leading cause of blindness worldwide and accounts for estimated cases of 18 million, half of all these cases originating in developing countries (6,7). Several large-scale population-based epidemiological studies consistently revealed strong links between obesity and cataract (5,(8)(9)(10)(11)(12). It is widely accepted that oxidative stress, osmotic stress, and nonenzymatic glycation of lens proteins are the primary mechanisms leading to cataract (13), and obesity might influence any or all of these physiological processes (14,15).…”